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Is my low back pain something more serious?

From fractures, cancer, kidney infection and more! Let's get into it and hopefully squash some worries.

Firstly, when talking about anything serious, I MUST preface this article by saying this is a generic guide only. If you are concerned please always speak to the appropriate healthcare professional. This article is not designed to diagnose any issues, just as an informational resource only.

As a physiotherapist, one of my jobs during our assessment is to screen for any serious conditions and signpost clients onwards if it's needed. Sometimes more complex medical conditions can mimic the symptoms of common problems like back pain. I always air on the side of caution, and if any symptoms cause me any concern I'll always recommend a visit to the GP.

So what am I screening for?

Cauda Equina

Cauda what now?!

Cauda equina is probably the least well known condition but is probably one of the most serious and time sensitive problems that can occur. This is when something within the spine is squashing the 'horses tail' like nerves at the end of the spinal chord. It can cause one or more of the following:

- Reduced or complete Inability to empty the bladder

- Numbness of the groin and genitals

- Incontinence of the bowel

- Sudden change to sexual function

If you experience ANY of the above you MUST head to A&E straight away. When symptoms are left they can cause irreversible damage.

Back pain or kidney infection?

The BEST way to differentiate between a problem that is either musculoskeletal (bones, ligaments, nerves, muscles, joints etc) or visceral (organs) is to look closer at your aggravating and easing factors.

Aggravating factors are things that you do that cause the pain to get worse.

For example:

- Sitting for long periods

- bending forwards

- putting shoes on

- standing on one leg

- repetitive twisting

Classically back pain has some pretty obvious patterns to the pain. If you're not sure try and make a pain diary where you write down every time you get pain, and what you were just doing before that. You may start to notice a pattern.

Easing factors are just as important as aggravating factors. Easing factors are anything you can do to reduce the pain you feel. It's important to note, when talking about easing factors they don't have to get rid of the pain completely! They just need to reduce the pain, even short term. These could be:

- Hot baths/showers/hot water bottle

- Volterol

- lying or sitting in certain positions

- Certain stretches that feel relieving

- Massaging certain areas

However when it comes to visceral pain there are no movement patterns that will aggravate or ease the pain. You won't be able to find a position in bed that feels comfy, no movements will cause the pain to get worse and you won't be able to press the pain (with muscular back pain you can usually find a sore bit on your back or pelvis that brings on more intense pain when you press it). Usually with a kidney infection you may get one or more of the following symptoms:

- A urinary infection

- Pain passing urine

- Blood in your urine

- Fever like symptoms such as getting hot/cold

- Only on one side (compared to back pain that may spread over both sides)

If you're concerned you have a kidney infection, get in contact with your local GP.

Have I broken/fractured my back?

Breaking your back is actually not as uncommon as you might think...however unless it affects your nerves, the treatment is usually very conservative and you'll be back in no time!

Firstly lets talk about the obvious cause of fracture - traumatic. If you suffer a fall where you hit your back its always a good idea to get some medical assistance. If you have any changed sensations in your lower body immediately after the accident or severe pain, it's really important that you call an ambulance and you try not to move. Wait until the paramedics have assessed you, because if you move you could make things worse.

The next most common cause is with osteoporosis. Osteoporosis is where there is reduced bone density. It is more common in women than men and usually occurs over the age of 60, with an increasing risk the older you get. Because the bone density has reduced, it takes much less force for a fracture to occur. If you've had a small fall or a strong nudge in the back or jolt, followed by intense pain, especially when bending backwards then its definitely a good idea to either go to minor injuries or see your GP.

The final type of fracture we'll talk about on here is the pars fracture. This usually occurs to the younger audience in teens to early twenties. Very common in sports like gymnastics, dancing and football (goal keepers in particular). It is caused by excessive extension (bending backwards/arching of the spine). Pain usually occurs:

- straight after the offending activity

- pain and stiffness when moving from being still for periods

- Pain on bending backwards

- dull deep ache after doing activity

If you're concerned this may be present for you, go to minor injuries or see your GP.

Is my back pain actually cancer?

Cancer can present in many ways, dependent upon lots of factors. I am not an oncologist or an oncology specialist physiotherapist. It takes a specialist to diagnose any form of cancer. This blog post is in no way designed to do that. That being said, there are symptoms that we keep an eye out for that I always recommend anyone presenting with them to talk to their GP.

- Unexplained weight loss: Whilst it might seem the dream for many of us to lose weight without even trying, it actually is a sign the body is working harder and therefore burning more calories that it should be. If you've noticed your weight going down or your clothes are getting looser on you without explanation ( so no diet changes, increased exercise, high stressful periods etc) then definitely have a chat with the GP.

- Unremitting night pain: Many people with back pain will have pain at night. However unremitting back pain means that it doesn't matter how you like, there is no position that is comfortable. It is very difficult to get to sleep due to the pain and you are woken up by the pain without moving. Many people have very high levels of pain and may even resort to sleeping in recliner chairs downstairs than go to bed.

- Feeling fatigued/lethargic: This one is a little vague as this could be caused by a number of things like nutritional deficiency, stressful period in life etc. But if this has been going on for a while with no known cause I'd definitely speak to the GP. Usually it is a nutritional deficiency, in which case it can get solved for you.

- Family history of cancer: There are certain cancers that have stronger hereditary components than others. Whilst this is definitely not a diagnostic factor alone, it is definitely something I take into account when assessing any clients I see in conjunction with other symptoms.

So although we have talked about very serious conditions that can affect the spine, I hope having more information has helped to settle your mind about the symptoms you may be having. However as I mentioned earlier, if you are concerned please speak to a healthcare professional who can point you in the right direction.


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